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Journal of Postgraduate Medicine, Vol. 48, Issue 4, 2002 pp. 287, 289 Spot the Diagnosis A triad of radiological signs
A 45-year-old male presented with swelling and pain of the left great toe for the past 4 months. The patient also gave history of low-grade evening rise of temperature for the past four months. On clinical examination there was a swelling of the first metatarsophalangeal joint which was minimally tender but with no local rise of temperature. The patient was a known case of pulmonary tuberculosis detected five years ago and took adequate four-drug anti tuberculous therapy for the same. Investigations revealed an ESR of 63 mm at the end of 1 hour. The radiograph of the left foot is shown in Figure 1. Rheumatoid factor was negative. What is your diagnosis for this condition? Diagnosis is tuberculosis of the left 1st metatarsophalangeal joint. Radiograph of the left foot showed decrease in the joint space of first metatarsophalangeal joint with peripherally located osseous erosion of the first metatarsal on the lateral aspect with decrease in the joint space (Figure 1). Also minimal juxtaarticular ostepenia of the first metatarsal and proximal phalange was noted. (Phemister's triad). Aspirate of the joint grew acid-fast bacilli on culture confirming the diagnosis of tuberculosis. The patient was started on antituberculous therapy and showed significant decrease in the joint swelling by the end of three months. Asrani A, Chavan G, Jain J Department of Radiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai - 400012. India. E-mail: ashwinasrani@yahoo.com This article is also available in full-text from http://www.jpgmonline.com/ © Copyright 2002 - Journal of Postgraduate Medicine The following images related to this document are available:Photo images[jp02117f1.jpg] |
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